- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.72 / $255.75 / $274.64
| Professional | | $219.72 | $255.75 | $274.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.18 / $27.19 / $321.33
| Facility | | $27.18 | $27.19 | $321.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.18 / $29.28 / $346.06
| Professional | | $27.18 | $29.28 | $346.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.34 / $240.34 / $464.91
| Facility | | $240.34 | $240.34 | $464.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $240.34 / $298.26
| Professional | | $33.42 | $240.34 | $298.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.41 / $247.45 / $364.50
| Professional | | $170.41 | $247.45 | $364.50 |